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it <br /> STATE P.O. BOX 807,SAN FRANCISCO, CA 94101-0807 <br /> COMPENSATION <br /> IfVSUR AfVCE <br /> FUND CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br /> "Irtr(c,ri le 1990 POLICYNUM13ER: <br /> CERTIFICATE EXPIRES: <br /> r <br /> r0 <br /> LV.it`IT1 UF an+'1 ,1rIAt ; x a <br /> �:JKLIC HcALTH SEriv�% ES <br /> 0 *OX 45X001 <br /> { <br /> 6TOCKT0114 <br /> CA y5201 JJw; CI ^NTgACT LiCr�v ;Y nj>17575 <br /> t� <br /> ALL jO-,S :'4 C�:J",TY <br /> L <br /> This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the California <br /> Insurance Commissioner to the employer named below for the policy period indicated. <br /> Thispo y lic is not subject to cancellation by the Fund except upon ten <br /> days'advance written notice to the employer. <br /> I <br /> We will also give you TE�Adays'advance notice should this policy be cancelled prior to its normal expiration. <br /> This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded by the <br /> policies listed herein. Notwithstanding any requirement, term, or condition of any contract or other document with <br /> respect to which this certificate of insurance may be issued or may pertain, the insurance afforded by the policies <br /> described herein is subject to all the terms, exclusions and conditions of such policies. ` <br /> PRESIDENT <br /> f <br /> a <br /> E�Ot1�+ c �lEi�T s,Oo-) E,41TLEG CEJ�TIf ICATi nOLC :Hy ' hl)T !, i zf <br /> 03/U5/93 1 ATT,iChl-o rO AND FQkt ,IS A FART Of TnI S OOLICY. <br /> ©IG. <br /> � cb <br /> EMPLOYER <br /> I <br /> i r <br /> I f1 { ttfY 111 <br /> { ✓t IT,4 A TALLIA! 1NC <br /> P U -lox 950 <br /> 3i+1h1 ��tif)Ft*li5 <br /> i CA - = 5244 <br /> j` <br />( SCIF 10262(REV.10-86) OQPY FOR INSUREp'S F LE OLE)262A <br />